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I’ve been billed for missing an appointment that my doctor cancelled twice!

The question: I just received a $50 bill from my doctor for a missed appointment. The irony is that I had rebooked that appointment twice because my doctor had cancelled both times. Are they allowed to charge me for the appointment and will I be able to see them before paying this bill?

The answer: This seems unfair given that you had to reschedule your time twice prior to the missed appointment. To answer your question though, your doctor is allowed to charge for a missed appointment or if there is a late cancellation of less than 24 hours.

There are some rules that your doctor's office has to follow: First, you must be informed of this policy before a charge is made. It must be clearly stated within a written agreement such as a pamphlet detailing the policy and potential charges. Often this is shared at a first visit or may be a notice that is clearly posted in your doctor's office. The fee should reasonably reflect the cost of the missed appointment, which would in general be about $30 for a regular appointment and $60 for a full physical. The doctor's office should also allow for patients to cancel appointments with ease. Sometimes it can be difficult to get through to a doctor during office hours, so ideally they would offer a cancellation option with voice mail or e-mail.

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Charging for missed appointments is done for a number of reasons. The primary reason is to discourage patients from missing appointments or cancelling late. It can be challenging to see a doctor in a short time due to large patient practices, so a missed appointment or "no-show" forfeits an appointment spot that another patient could have used. There is also the potential loss of income as the doctor cannot bill for the time that a patient was meant to be seen but was not.

In your case, given that you had to reschedule twice and that this is the first time you have missed an appointment, I would suggest speaking to your doctor about having this fee waived. For an isolated case, most doctors will waive the fee. Also, most doctors will also take into account the circumstances of the missed appointment along with the ability of the patient to pay prior to billing.

If you have a pending bill with your doctor, you should not be denied medical care. If missed appointments are an issue for a patient, I recommend working with the doctor's office to minimize this risk. Perhaps there is a time of day for you that works better such as first thing in the morning or the last available appointment of the day. If you don't want to wait for your doctor who may run behind, book the first appointment of the morning or the afternoon. You can ask the office if they offer e-mail or phone reminders for appointments which have been found to decrease no-shows. Remember though, if repeat missed appointments become an issue, generally greater than three, your doctor can terminate the relationship.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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